An Alternative to an Open Heart Surgery


August 1, 2019 | View PDF

What is Structural Heart Disease?

What use to be thought would require open heart surgery is quickly becoming no longer the case. Since 1999 research has shown the success of Interventional Cardiology and minimally invasive approaches to patients for complex disease. There is now a more simple solution for a complex problems.

Structural heart disease is a defect or abnormality of the heart that is nor-coronary, meaning that it does not affect the blood vessels in the heart. It is a disease you can be born with or can be caused by the wear and tear over time on your heart.

Common conditions treated by structural heart disease experts include: heart murmurs, rheumatic heart disease, cardiomyopathies, congenitally malformed valves, “blocked” or stenosed valves; “leaky” or insufficient/regurgitant valves as well as failed or malfunctioning prosthetic heart valves. Defects or “holes” in the heart such as atrial septal defect (ASD), patent foramen ovale (PFO) or patent ductus arteriosus (PDA).

A typical structural heart procedure involves making a small incision through the groin, then inserting a sheath (small tube) to navigate through the blood vessels to the procedure site within the heart. Next, the doctor guides the device through the small tube and deploys it in order to correct the diagnosis. Once the device is properly in place the small tube will be removed and procedure is completed!

Typically structural heart procedures range from 1-2 hours depending on the complexity. The majority of these procedures are done with light sedation and you will typically stay one night in the hospital.

The alternative to a structural heart procedure is commonly open heart surgery. With open heart surgery there is cracking of the chest, at least 5 nights in the hospital, and recovery can take up to 2-3 months.

Common Structural Heart Procedures:

Atrial Septal Defect (ASD) Closure

Atrial Septal Defect (ASD) is one of the most common congenital heart defects. It is a connection between the upper 2 chambers of the heart. Some people call this – hole in the heart. If left untreated it can lead to heart failure. Severity of symptoms often depends on the size of the hole. Large ASDs may cause fatigue, shortness of breath, pulmonary hypertension, arrhythmia. Most of the ASDs nowadays can be closed within 10 minutes by deploying a special device call ASD occluder, a special device made of braided Nitinol, a metal with shape memory characteristics. This means the device will go back to its original shape even after it is stretched to pass through a catheter.

Patent Foramen Ovale (PFO) Closure

A foramen ovale is a flap-like opening between the upper two chambers of the heart. It allows blood to flow from the right side of the heart to the left side. In some regards this opening is very similar to ASD. However it is much more common. It is present in everybody to birth to allow oxygen-rich blood from the mother to circulate throughout the fetus. After birth the foramen ovale fuses to form a solid wall (septum) because the right-to-left blood flow is no longer needed. However, in about 30% of people, the foramen ovale remains open, or patent, leaving a flap or tunnel which may open and close. It has been associated with a stroke, decompression illness (bends) and possibly migraines. Closure of this defect can prevent and/or alleviate these conditions. The procedure is very similar to the ASD closure.

MitraClip Procedure

Mitral regurgitation (MR) is a common heart disorder that causes blood to leak backwards through the heart’s mitral valve. The MitraClip is the first and only percutaneous device approved by the FDA to treat high-risk patients with mitral regurgitation. This procedure is also called edge-to-edge mitral valve repair. In recently published COAPT Trial Mitraclip device showed amazing benefit for patients with mitral regurgitation and Heart failure. Patients who received MitraClip were 47% less likely to be admitted to the hospital with worsening of their heart failure and 58% less likely to die at 2 years compare to medical therapy. All patients were high risk for open heart surgery.

Transcatheter Aortic Valve Replacement (TAVR)

Aortic stenosis is common condition afflicting many patients. Symptoms include shortness of breath, chest pain, syncope, heart failure, and fatigue. This most commonly occurs starting from in the 60s and is a result of calcification of the aortic valve that is a result of aging. This condition is detected by an Echocardiogram, which is an ultrasound of the heart. Traditionally, the treatment involved open heart surgery and removal of the native valve with replacement via a bioprosthetic valve or a

mechanical valve.

In the current era, a minimally invasive procedure involving the implantation of stented valve within the native aortic annulus has been developed and is known as Transcatheter Aortic Valve Replacement (TAVR). Majority of these procedures occur via a small incision in the groin where there is placement of a tube within the common femoral artery. The valve is them advanced into the native aortic valve over a wire and deployed with the heart still beating.

The original valve is left in place and acts as an anchor for the new valve. Given the avoidance of open-heart surgery, there is minimal recovery. A vast majority of patients being discharged the following day. For those patients who have smaller or diseased arteries within the leg, there are alternative access points involving the subclavian, carotid, and direct aortic access. Currently, there exist two main type of valves the Edwards Sapien S3 and the Medtronic Evolut R. This is an evolving field with the promise of many more valves to come.

Transcatheter Valve in Valve Procedure (ViV)

The FDA has recently approved placement of TAVR valves for the treatment of those patients who have failing bioprosthetic valves. Over time the surgically placed bioprosthetic valve can become tightened or leaky. Similar to implanting a TAVR valve in a native aortic valve, these valves can now be placed inside of previously surgically placed bioprosthetic valve. The struts of the bioprosthetic valve act as an anchor for the new valve. The advent of this technique allows patient to avoid a re-operation for their previously placed valve.

Perivalvular Leak (PVL) Closure

Occasionally, a previously placed surgical valve will have a leak that is outside of the valve typically involving the area between where the valve was sutured during surgery and the native valve itself. Since the leak is not within the valve itself, placement of a TAVR valve is not sufficient to treat this particular problem. In this scenario, there has been a development of a vascular plug that can occlude the leak allowing the patient to avoid a repeat open heart surgery.

Ashchi Heart & Vascular Center has cardiology experts on staff who specialize in managing, diagnosing and treating Structural Heart Disease. We use the latest technology and techniques to deliver the highest quality, patient-centric care. We also welcome patients seeking second opinions on their treatment options.

If you wish to make an appointment with our doctors, please contact us at (904) 222-6656 or visit our web site ( for our locations or phone numbers in three counties. We would like to thank the spectacular team at Memorial Hospital for continued their help and support as we grow our Structural Heart Program.

Anton Lishmanov MD. PhD is a Director of Structural Heart Interventions at Ashchi Heart& Vascular Center. He is by far one of the best-trained structural heart disease experts in Northeast Florida having performed a large volume of complex interventional procedures in some of the finest teaching centers in the USA. His training includes an internal medicine residency at the University of Missouri followed by an advanced fellowship in cardiology at the University of North Carolina at Chapel Hill, a Cardiac Critical Care Fellowship at Albert Einstein College of Medicine-Montefiore Medical Center and an Advanced Interventional Cardiovascular Fellowship at the prestigious University of Texas Health Science Center at Houston.

He is board certified in internal medicine, cardiovascular disease, cardiac critical care medicine, interventional cardiology and endovascular medicine. He is fluent in English and Russian.

Aalok D. Patel, MD is a new and welcomed addition to our growing team. He has trained at top institutions with the best mentors in the nation and brings an brings an unmatched expertise to Northeast Florida. His training includes an Internal Medicine Residency at the Emory University followed by a Cardiovascular Diseases Fellowship at the prestigious Mayo Clinic-Minnesota, and finally an Advanced Interventional Cardiovascular Fellowship at the Scripps Clinic, La Jolla where he trained in Coronary, Endovascular, and Structural Heart disease interventions. He is board certified in Internal Medicine, Cardiovascular Diseases, and Interventional Cardiology. He is fluent in English, Gujurati, and Hindi.

A Message from Ashchi Heart & Vascular Center...

I am pleased to announce the opening of my new medical practice dedicated to the delivery of high quality, comprehensive diagnostic and treatment services for patients experiencing simple to complex heart and vascular diseases. My staff and I continue a sincere commitment to serve each patient with the highest level of integrity and ethics just as we have for the tens of thousands of patients who have grown to know and depend on us for more than 20 years. Truly, our reputation is built on mutual trust and respect.

Visit our new dynamic website It offers ease of navigation, comprehensive information on health and wellness education, plus an interesting blog.

For your convenience, we have a single Central Scheduling appointment line and six regional locations offering Cardiology, Interventional Cardiology, Vascular Medicine (arteries & veins) Endovascular Medicine & Electrophysiology. We will check and manage pacemakers and AICD (defibrillators), as well as treat simple arrhythmias (atrial fibrillation or flutter) to the most complex, life-threatening arrhythmias.


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